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JOINT CIRCULAR No.31/2000/TTLT-BTC-BYT OF APRIL 25, 2000 GUIDING THE SETTING UP AND FINANCIAL MANAGEMENT OF SEMI-PUBLIC MEDICAL EXAMINATION AND TREATMENT ESTABLISHMENTS

Pursuant to the Government’s Decree No.73/1999/ND-CP of August 19, 1999 on the policy of encouraging the socialization of activities in the fields of education, health care, culture and sports; the Ministry of Finance and the Ministry of Health hereby jointly guide the setting up and financial management of semi-public medical examination and treatment establishments as follows:

I. GENERAL PROVISIONS:

1. Semi-public medical examination and treatment establishments are set in two following forms:

- Semi-public hospitals and semi-public general examination rooms;

- Public hospitals with semi-public sections and public general examination rooms with semi-public divisions.

2. Principles for setting up semi-public medical examination and treatment establishments:

- Semi-public hospitals and semi-public general examination rooms are set up on the basis of link-up between units of State organizations and organizations other than the State ones or individuals of all economic sectors in the country, to newly set up or transform the entire public medical examination and treatment establishments with joint investment in infrastructure construction, hospital equipment and facilities as well as joint management and administration of all activities the medical examination and treatment establishments according to law provisions.

- Public hospitals with semi-public sections and public general examination rooms with semi-public divisions mean the link-up between public medical examination and treatment establishments and organizations other than the State ones or individuals of all economic sectors in the country in order to build or upgrade material bases and facilities for a section, a department or a number of departments of a hospital as well as to manage and administer all activities of the semi-public section according to law provisions.

- The setting up of semi-public medical examination and treatment establishments shall be considered on the basis of the demand determined by the Ministry of Health under the planning on organization of medical examination and treatment network as well as the people’s demand for medical examination and treatment nationwide.

- The setting up of semi-public medical examination and treatment sections in public medical examination and treatment establishments shall be considered on the basis of the people’s demand for medical examination and treatment in localities.

3. Semi-public medical examination and treatment establishments shall follow the medical professional and technical regulations like the public medical examination and treatment establishments as well as other relevant provisions of law.

4. Semi-public medical examination and treatment establishments shall provide medical examination and treatment services for those people who voluntarily pay for medical services according to the provisions of this Circular.

5. Subject to this Circular are semi-public medical examination and treatment establishments. Particularly for people-founded and private medical examination and treatment establishments, the provisions of the September 30, 1993 Ordinance on Private Medical and Pharmaceutical Practice, the legal documents guiding the implementation of this Ordinance and other relevant legal documents shall be complied with.

6. People-founded, private and semi-public medical examination and treatment establishments shall all be entitled to the policy of socialization encouragement stipulated in Circular No.18/2000/TT-BTC of March 1st, 2000 guiding a number of Articles of the Government’s Decree No.73/1999/ND-CP of August 19, 1999 on the incentive financial regime applicable to non-public establishments in the fields of education, health care, culture and sports.

II. SPECIFIC PROVISIONS:

A. CRITERIA AND CONDITIONS FOR SETTING UP OF SEMI-PUBLIC MEDICAL EXAMINATION AND TREATMENT ESTABLISHMENTS:

1. To meet the people’s demand for voluntary medical examination and treatment.

2. To have a contingent of medical cadres with full professional qualifications as defined by the Health Ministry.

3. To ensure infrastructure and modern medical equipment and facilities; to treat solid, liquid and gaseous wastes strictly according to regulations; to ensure environmental hygiene, not causing pollution and apply environmental protection measures.

4. To be able to mobilize resources from among the population and organizations of all economic sectors in the country so as to develop medical examination and treatment activities for people.

B. DOSSIER, PROCEDURES AND COMPETENCE TO PERMIT THE SETTING UP OF SEMI-PUBLIC MEDICAL EXAMINATION AND TREATMENT ESTABLISHMENTS:

1. A dossier for setting up of a semi-public medical examination and treatment establishment includes:

1.1. The application for setting up

1.2. The setting-up plan, which reflects the following contents:

- The necessity to set up the semi-public medical examination and treatment establishment;

- The investing parties;

- The total investment capital, including the capital contributed by the parties;

- The financial management mechanism;

- The infrastructure construction plan (improvement or construction of a semi-public hospital, departments or examination rooms; the size of the semi-public medical examination and treatment establishment or public establishment that has a semi-public section; the construction items in support of waste treatment; the total construction and improvement cost; the implementation tempo...);

- The specialized equipment and facilities: the list, value of each equipment or facility, the total investment capital for equipment and facilities;

- The managerial apparatus and staff (the number of personnel and their professional qualifications);

- The composition of the Managing Board and list of its members;

- The scope of professional practice;

- The analysis of the economic and financial efficiency.

2. Founding procedures: The Health Ministry shall provide separate guiding documents for semi-public medical examination and treatment establishments.

3. Competence to permit the setting up, merger, division, split, dissolution and suspension of operations of semi-public medical examination and treatment establishments:

3.1. Competence to permit the setting up:

- The Health Minister shall propose the Prime Minister to decide the founding of large-scale semi-public hospitals with investment capital equivalent to that of a group-A project of national or international characters.

- The Health Minister shall decide the founding of semi-public medical examination and treatment establishments under the Health Ministry.

- The ministers, the heads of the ministerial-level agencies and agencies attached to the Government shall decide the setting up of semi-public medical examination and treatment establishments under their respective ministries or branches. Particularly for the transformation of public hospitals under such ministries or branches into semi-public medical examination and treatment establishments, the written consent of the Health Minister is required.

- The directors of the provincial/municipal Health Services shall propose the presidents of the People’s Committees of the provinces and centrally-run cities to decide the setting up of the locally-run semi-public medical examination and treatment establishments. Particularly for the transformation of the locally-run public medical examination and treatment establishments into semi-public medical examination and treatment establishments, the Health Minister’s written consent is required.

3.2. Competence to decide the merger, division, split, dissolution and suspension of operations of semi-public medical examination and treatment establishments: The managerial level that is competent to decide the founding of semi-public medical examination and treatment establishments shall also have the competence to decide the merger, division, split, dissolution and suspension of operations of such establishments after consulting the concerned functional agencies.

4. Semi-public medical examination and treatment establishments shall, after obtaining founding decisions from the competent agencies, have to register with the financial agencies of the same level, submit to the inspection and supervision by the financial agencies and specialized management agencies of different levels.

C. MANAGEMENT, PROFESSIONAL OPERATIONS OF SEMI-PUBLIC MEDICAL EXAMINATION AND TREATMENT ESTABLISHMENTS:

- Semi-public medical examination and treatment establishments shall be subject to the State management by the health service and have to implement the hospital regulations, the medical professional and technical regulations and other relevant provisions of law.

- The directors of public units having semi-public medical examination and treatment establishments shall have to inspect, supervise and take responsibility before the State for the entire operations of the semi-public medical examination and treatment establishments under their respective units.

- The agencies permitting the setting up of semi-public medical examination and treatment establishments shall have the right to retrieve permits from those medical examination and treatment establishments that operate in contravention of law.

- The health service shall have to inspect and examine the professional operations of semi-public medical examination and treatment establishments and handle violations according to law provisions.

D. FINANCIAL MANAGEMENT REGIME FOR SEMI-PUBLIC MEDICAL EXAMINATION AND TREATMENT ESTABLISHMENTS:

1. Sources of operation capital:

- The State budget capital;

- The capital added from the annual financial results;

- The fixed asset depreciation (belonging to the State budget’s capital left for the establishments);

- The revenues from asset liquidation (belonging to the State budget capital sources);

- Sources of financial support, aids, donations or gifts of organizations and individuals inside and outside the country;

- The capital contributed by organizations and/or individuals for investment in the construction, improvement, expansion or upgrading of material bases, equipment and facilities;

- The capital borrowed from banks and credit institutions;

- Other capital sources.

2. Contents of financial revenues and expenditures:

2.1. Revenues:

- The hospital fees;

- The interests on bank deposits;

- The fund allocated for realization of programs, targets, subjects and projects already approved by the competent authorities;

- The other revenues arising in the course of operation of semi-public medical examination and treatment establishments.

2.2 Expenditures:

- The expense for wage, remuneration and allowances (if any). Full-time officials of semi-public medical examination and treatment establishments, shall be entitled to the wage regime prescribed for the production and business sector; for officials of public medical examination and treatment establishments who work on the part-time basis for the semi-public sections, the wage shall be paid in form of remuneration according to each person’s extent of participation in the work.

- The expense for contributions prescribed by law (social insurance and medical insurance premiums, trade union fees for laborers).

- The expense for the purchase of medicines, blood, fluids, chemicals, medical supplies and instruments to be used directly for patients under doctors’ prescriptions (calculated according to the prices bought by the semi-public establishment).

- The logistical expense in service of medical examination and treatment work (including charges of electricity, water, environmental hygiene, office supplies, information, propagation, communication, working travel allowances, conference expense...).

- The expense for scientific research and training in direct service of medical examination and treatment.

- The expense for regular maintenance and repair of fixed assets in service of professional work and infrastructure projects.

- The payment for rent of material bases.

- The expense for hiring domestic and foreign (if any) specialists.

- The expense for fixed asset depreciation. The fixed asset depreciation amount, if belonging to the State’s contributed capital, shall be left for reinvestment in the semi-public medical examination and treatment establishment, and if belonging to the loan and mobilized capital, shall be used for repayment of the principals of such loan and mobilized capital. The management and use of fixed asset depreciation fund shall comply with the current law provisions. In special cases, the directors of semi-public medical examination and treatment establishments and directors of public medical examination and treatment establishments having semi-public sections may decide the application of the quick depreciation rates compatible to the patients’ payment capability.

- The payment of interests on capital (if any) borrowed from or contributed by organizations and individuals.

- The other expenses.

- The payable taxes (if any).

2.3. The annual financial results of semi-public medical examination and treatment establishments shall be determined on the basis of the difference between the total hospital-fee revenues and expenditures in the fiscal year after they fulfill the State budget remittance obligation according to law provisions. Such difference shall be dealt with as follows:

- To deduct at least 30% for supplement to the operation capital sources and upgrade material bases for semi-public medical examination and treatment establishments and public units having semi-public sections (the concrete level of supplement to the operation capital sources for the public units and semi-public sections shall be decided by the Management Boards).

- The remainder shall be spent on the following contents according to the rates set by the Management Boards:

+ Reward and welfare for laborers in the semi-public medical examination and treatment establishments, public units having semi-public sections and subjects in direct cooperation with the units.

+ Establishment of medical examination and treatment reserve funds in order to offset the hospital fee exemption and reduction for social policy beneficiaries, poor people and people with meritorious services to the revolution.

+ Distribution to members according to the proportion of capital contribution by the State, collectives and individuals to semi-public medical examination and treatment establishments. The income originated from the State budget’s contributed capital shall be left for the units to enhance investment in their material bases and accounted as the increase of the State budget capital contribution thereat.

3. Financial management regime:

3.1. For capital contributed by the State, including capital in cash (the retained surplus difference between revenues and expenditures originated from the State’s contributed capital); the supplies, goods and fixed assets (houses, land, machinery and equipment, transport means and other assets), which are provided by the State budget as the initial equipment and handed over to the establishments in the operation course:

- The public medical examination and treatment establishments shall have to organize the inventory and reevaluation of the State’s entire contributed capital transferred to the semi-public establishments and send the reports thereon to the management agencies for consideration and approval as well as to the financial agencies of the same level for the clearance of procedures for the hand-over of the State’s assets and capital to the semi-public establishments.

- The directors of semi-public medical examination and treatment establishments shall have to preserve capital in the course of operation.

- Annually, semi-public medical examination and treatment establishments shall inventory and revalue assets, supplies and capital and submit reports thereon to their superior management bodies and finance agencies of the same level according to current regulations.

3.2. The capital supplemented by establishments themselves such as the retained fixed asset depreciation, the supplement from the annual financial results, must be used and managed according to current regulations.

3.3. The fund allocated by the State budget for realization of programs, targets, subjects and projects must be managed and used for the right purposes already approved and in strict compliance with the State’s current financial expenditure regime.

3.4. Semi-public medical examination and treatment establishments must use the capital contributed by organizations and individuals of all economic sectors as well as the capital borrowed from banks and credit institutions, for the right purposes, in an efficient manner and according to the debt (principal and interest) repayment plan in strict compliance with their commitments made when mobilizing capital.

3.5. Semi-public medical examination and treatment establishments, when having a demand for sale or liquidation of assets belonging to the State’s contributed capital must obtain decision from their superior management bodies after getting the written opinions of the finance agencies of the same level so as to ensure the strict observance of the prescribed regimes on the management of public properties. For the sale of redundant or technically obsolete assets to recover capital, the price-determining council must be set up and auction shall be organized according to law. The proceeds from the sale of assets, after deducting the reasonable sale expenses, shall be used to supplement the operation capital of the units and divided according to the proportion of initial capital contribution to create such assets.

3.6. Assets pledged or mortgaged to borrow capital at credit institutions shall strictly comply with the current law provisions.

3.7. Semi-public medical examination and treatment establishments shall have to open accounting books to monitor all existing assets and capital, the situation on changes of assets and capital of the units in strict accordance with the current accounting regime.

3.8. The hospital fee rates shall be set by the directors of semi-public medical examination and treatment establishments for each service and submitted to the managing ministries and branches (for semi-public medical examination and treatment establishments under the ministries and branches run by the central government) and the People’s Committees of the provinces and centrally-run cities (for the locally-run semi-public medical examination and treatment establishments) for appraisal and ratification.

3.9. Semi-public medical examination and treatment establishments shall be entitled to open accounts at the State Treasuries to receive the State budget allocations to realize programs, targets, schemes and projects; aid sources and other supports, and open accounts at banks to collect hospital fees and units’ other revenues.

4. The work of making cost estimates:

Semi-public medical examination and treatment establishments shall have to make annual and quarterly cost estimates for their entire operations, including:

- The estimated hospital-fee revenues and expenditures, service charges and other revenue sources (if any);

- The plan on distribution of revenue-expenditure differences and the establishment of funds;

- The estimated expenditures from fixed asset depreciation fund, incomes from the State’s contributed capital left for the semi-public medical examination and treatment establishments.

The above-mentioned cost estimates shall be sent to the management agencies for synthesization and sending to the finance agencies of the same level.

5. The heads of semi-public medical examination and treatment establishments shall be the account owners of their respective units and answerable to the Management Boards and their immediate superior management bodies for the entire work of managing finance and assets of the establishments.

6. Organization of accounting and final account settlement:

- Semi-public medical examination and treatment establishments shall organize the accounting and statistical work and open their own monitoring books according to the provisions of the Ordinance on Accounting and Statistics as well as the relevant legal documents.

- Quarterly and annually, semi-public medical examination and treatment establishments shall make final account settlement reports according to the prescribed forms and tables. For semi-public hospitals and general examination rooms, they must send their final account settlement reports to their superior management bodies for consideration, approval, synthesization and sending to the finance agencies of the same level; For public hospitals and general examination rooms having semi-public sections, they must incorporate the final account settlements of the semi-public sections into the general final account settlement report to be sent to the superior management bodies which shall directly consider and approve before sending them to the finance agencies of the same level.

7. Regularly or extraordinarily, the finance agencies of the same level shall coordinate with the management agencies in inspecting and supervising the observance of the financial regime as well as the execution of professional regulations by semi-public medical examination and treatment establishments.

8. Publicization of annual financial reports: On the basis of the annual final settlement reports already approved by the competent agencies, semi-public medical examination and treatment establishments shall publicize their final account settlement reports before the conferences of employees of their respective units.

III. IMPLEMENTATION PROVISIONS

This Circular takes effect 15 days after its signing. In the course of implementation, if any problems arise, they should be promptly reported to the Finance Ministry and the Health Ministry for consideration, appropriate amendment and supplement.

For the Finance Minister

Vice Minister
NGUYEN THI KIM NGAN

For the Health Minister

Vice Minister
LE NGOC TRONG